Conceptual framework for the design, implementation and validation of psychomotor skills’ assessment systems in minimally invasive surgery

Las técnicas de cirugía de mínima invasión (CMI) se están consolidando hoy en día como alternativa a la cirugía tradicional, debido a sus numerosos beneficios para los pacientes. Este cambio de paradigma implica que los cirujanos deben aprender una serie de habilidades distintas de aquellas requeridas en cirugía abierta. El entrenamiento y evaluación de estas habilidades se ha convertido en una de las mayores preocupaciones en los programas de formación de cirujanos, debido en gran parte a la presión de una sociedad que exige cirujanos bien preparados y una reducción en el número de errores médicos. Por tanto, se está prestando especial atención a la definición de nuevos programas que permitan el entrenamiento y la evaluación de las habilidades psicomotoras en entornos seguros antes de que los nuevos cirujanos puedan operar sobre pacientes reales. Para tal fin, hospitales y centros de formación están gradualmente incorporando instalaciones de entrenamiento donde los residentes puedan practicar y aprender sin riesgos. Es cada vez más común que estos laboratorios dispongan de simuladores virtuales o simuladores físicos capaces de registrar los movimientos del instrumental de cada residente. Estos simuladores ofrecen una gran variedad de tareas de entrenamiento y evaluación, así como la posibilidad de obtener información objetiva de los ejercicios. Los diferentes estudios de validación llevados a cabo dan muestra de su utilidad; pese a todo, los niveles de evidencia presentados son en muchas ocasiones insuficientes. Lo que es más importante, no existe un consenso claro a la hora de definir qué métricas son más útiles para caracterizar la pericia quirúrgica. El objetivo de esta tesis doctoral es diseñar y validar un marco de trabajo conceptual para la definición y validación de entornos para la evaluación de habilidades en CMI, en base a un modelo en tres fases: pedagógica (tareas y métricas a emplear), tecnológica (tecnologías de adquisición de métricas) y analítica (interpretación de la competencia en base a las métricas). Para tal fin, se describe la implementación práctica de un entorno basado en (1) un sistema de seguimiento de instrumental fundamentado en el análisis del vídeo laparoscópico; y (2) la determinación de la pericia en base a métricas de movimiento del instrumental. Para la fase pedagógica se diseñó e implementó un conjunto de tareas para la evaluación de habilidades psicomotoras básicas, así como una serie de métricas de movimiento. La validación de construcción llevada a cabo sobre ellas mostró buenos resultados para tiempo, camino recorrido, profundidad, velocidad media, aceleración media, economía de área y economía de volumen. Adicionalmente, los resultados obtenidos en la validación de apariencia fueron en general positivos en todos los grupos considerados (noveles, residentes, expertos). Para la fase tecnológica, se introdujo el EVA Tracking System, una solución para el seguimiento del instrumental quirúrgico basado en el análisis del vídeo endoscópico. La precisión del sistema se evaluó a 16,33ppRMS para el seguimiento 2D de la herramienta en la imagen; y a 13mmRMS para el seguimiento espacial de la misma. La validación de construcción con una de las tareas de evaluación mostró buenos resultados para tiempo, camino recorrido, profundidad, velocidad media, aceleración media, economía de área y economía de volumen. La validación concurrente con el TrEndo® Tracking System por su parte presentó valores altos de correlación para 8 de las 9 métricas analizadas. Finalmente, para la fase analítica se comparó el comportamiento de tres clasificadores supervisados a la hora de determinar automáticamente la pericia quirúrgica en base a la información de movimiento del instrumental, basados en aproximaciones lineales (análisis lineal discriminante, LDA), no lineales (máquinas de soporte vectorial, SVM) y difusas (sistemas adaptativos de inferencia neurodifusa, ANFIS). Los resultados muestran que en media SVM presenta un comportamiento ligeramente superior: 78,2% frente a los 71% y 71,7% obtenidos por ANFIS y LDA respectivamente. Sin embargo las diferencias estadísticas medidas entre los tres no fueron demostradas significativas. En general, esta tesis doctoral corrobora las hipótesis de investigación postuladas relativas a la definición de sistemas de evaluación de habilidades para cirugía de mínima invasión, a la utilidad del análisis de vídeo como fuente de información y a la importancia de la información de movimiento de instrumental a la hora de caracterizar la pericia quirúrgica. Basándose en estos cimientos, se han de abrir nuevos campos de investigación que contribuyan a la definición de programas de formación estructurados y objetivos, que puedan garantizar la acreditación de cirujanos sobradamente preparados y promocionen la seguridad del paciente en el quirófano. Abstract Minimally invasive surgery (MIS) techniques have become a standard in many surgical sub-specialties, due to their many benefits for patients. However, this shift in paradigm implies that surgeons must acquire a complete different set of skills than those normally attributed to open surgery. Training and assessment of these skills has become a major concern in surgical learning programmes, especially considering the social demand for better-prepared professionals and for the decrease of medical errors. Therefore, much effort is being put in the definition of structured MIS learning programmes, where practice with real patients in the operating room (OR) can be delayed until the resident can attest for a minimum level of psychomotor competence. To this end, skills’ laboratory settings are being introduced in hospitals and training centres where residents may practice and be assessed on their psychomotor skills. Technological advances in the field of tracking technologies and virtual reality (VR) have enabled the creation of new learning systems such as VR simulators or enhanced box trainers. These systems offer a wide range of tasks, as well as the capability of registering objective data on the trainees’ performance. Validation studies give proof of their usefulness; however, levels of evidence reported are in many cases low. More importantly, there is still no clear consensus on topics such as the optimal metrics that must be used to assess competence, the validity of VR simulation, the portability of tracking technologies into real surgeries (for advanced assessment) or the degree to which the skills measured and obtained in laboratory environments transfer to the OR. The purpose of this PhD is to design and validate a conceptual framework for the definition and validation of MIS assessment environments based on a three-pillared model defining three main stages: pedagogical (tasks and metrics to employ), technological (metric acquisition technologies) and analytical (interpretation of competence based on metrics). To this end, a practical implementation of the framework is presented, focused on (1) a video-based tracking system and (2) the determination of surgical competence based on the laparoscopic instruments’ motionrelated data. The pedagogical stage’s results led to the design and implementation of a set of basic tasks for MIS psychomotor skills’ assessment, as well as the definition of motion analysis parameters (MAPs) to measure performance on said tasks. Validation yielded good construct results for parameters such as time, path length, depth, average speed, average acceleration, economy of area and economy of volume. Additionally, face validation results showed positive acceptance on behalf of the experts, residents and novices. For the technological stage the EVA Tracking System is introduced. EVA provides a solution for tracking laparoscopic instruments from the analysis of the monoscopic video image. Accuracy tests for the system are presented, which yielded an average RMSE of 16.33pp for 2D tracking of the instrument on the image and of 13mm for 3D spatial tracking. A validation experiment was conducted using one of the tasks and the most relevant MAPs. Construct validation showed significant differences for time, path length, depth, average speed, average acceleration, economy of area and economy of volume; especially between novices and residents/experts. More importantly, concurrent validation with the TrEndo® Tracking System presented high correlation values (>0.7) for 8 of the 9 MAPs proposed. Finally, the analytical stage allowed comparing the performance of three different supervised classification strategies in the determination of surgical competence based on motion-related information. The three classifiers were based on linear (linear discriminant analysis, LDA), non-linear (support vector machines, SVM) and fuzzy (adaptive neuro fuzzy inference systems, ANFIS) approaches. Results for SVM show slightly better performance than the other two classifiers: on average, accuracy for LDA, SVM and ANFIS was of 71.7%, 78.2% and 71% respectively. However, when confronted, no statistical significance was found between any of the three. Overall, this PhD corroborates the investigated research hypotheses regarding the definition of MIS assessment systems, the use of endoscopic video analysis as the main source of information and the relevance of motion analysis in the determination of surgical competence. New research fields in the training and assessment of MIS surgeons can be proposed based on these foundations, in order to contribute to the definition of structured and objective learning programmes that guarantee the accreditation of well-prepared professionals and the promotion of patient safety in the OR.

Systems and technologies for objective evaluation of technical skills in laparoscopic surgery

Minimally invasive surgery is a highly demanding surgical approach regarding technical requirements for the surgeon, who must be trained in order to perform a safe surgical intervention. Traditional surgical education in minimally invasive surgery is commonly based on subjective criteria to quantify and evaluate surgical abilities, which could be potentially unsafe for the patient. Authors, surgeons and associations are increasingly demanding the development of more objective assessment tools that can accredit surgeons as technically competent. This paper describes the state of the art in objective assessment methods of surgical skills. It gives an overview on assessment systems based on structured checklists and rating scales, surgical simulators, and instrument motion analysis. As a future work, an objective and automatic assessment method of surgical skills should be standardized as a means towards proficiency-based curricula for training in laparoscopic surgery and its certification.

How can video analysis help laparoscopic surgeons?

Automatic analysis of minimally invasive surgical (MIS) video has the potential to drive new solutions that alleviate existing needs for safer surgeries: reproducible training programs, objective and transparent assessment systems and navigation tools to assist surgeons and improve patient safety. As an unobtrusive, always available source of information in the operating room (OR), this research proposes the use of surgical video for extracting useful information during surgical operations. Methodology proposed includes tools' tracking algorithm and 3D reconstruction of the surgical field. The motivation for these solutions is the augmentation of the laparoscopic view in order to provide orientation aids, optimal surgical path visualization, or preoperative virtual models overlay

Minimally invasive surgical video analysis: a powerful tool for surgical training and navigation

Analysis of minimally invasive surgical videos is a powerful tool to drive new solutions for achieving reproducible training programs, objective and transparent assessment systems and navigation tools to assist surgeons and improve patient safety. This paper presents how video analysis contributes to the development of new cognitive and motor training and assessment programs as well as new paradigms for image-guided surgery.

Minimally invasive surgical video analysis: a powerful tool for surgical training and navigation

Analysis of minimally invasive surgical videos is a powerful tool to drive new solutions for achieving reproducible training programs, objective and transparent assessment systems and navigation tools to assist surgeons and improve patient safety. This paper presents how video analysis contributes to the development of new cognitive and motor training and assessment programs as well as new paradigms for image-guided surgery.

Machine Learning in Scientometrics

El aprendizaje automático y la cienciometría son las disciplinas científicas que se tratan en esta tesis. El aprendizaje automático trata sobre la construcción y el estudio de algoritmos que puedan aprender a partir de datos, mientras que la cienciometría se ocupa principalmente del análisis de la ciencia desde una perspectiva cuantitativa. Hoy en día, los avances en el aprendizaje automático proporcionan las herramientas matemáticas y estadísticas para trabajar correctamente con la gran cantidad de datos cienciométricos almacenados en bases de datos bibliográficas. En este contexto, el uso de nuevos métodos de aprendizaje automático en aplicaciones de cienciometría es el foco de atención de esta tesis doctoral. Esta tesis propone nuevas contribuciones en el aprendizaje automático que podrían arrojar luz sobre el área de la cienciometría. Estas contribuciones están divididas en tres partes: Varios modelos supervisados (in)sensibles al coste son aprendidos para predecir el éxito científico de los artículos y los investigadores. Los modelos sensibles al coste no están interesados en maximizar la precisión de clasificación, sino en la minimización del coste total esperado derivado de los errores ocasionados. En este contexto, los editores de revistas científicas podrían disponer de una herramienta capaz de predecir el número de citas de un artículo en el fututo antes de ser publicado, mientras que los comités de promoción podrían predecir el incremento anual del índice h de los investigadores en los primeros años. Estos modelos predictivos podrían allanar el camino hacia nuevos sistemas de evaluación. Varios modelos gráficos probabilísticos son aprendidos para explotar y descubrir nuevas relaciones entre el gran número de índices bibliométricos existentes. En este contexto, la comunidad científica podría medir cómo algunos índices influyen en otros en términos probabilísticos y realizar propagación de la evidencia e inferencia abductiva para responder a preguntas bibliométricas. Además, la comunidad científica podría descubrir qué índices bibliométricos tienen mayor poder predictivo. Este es un problema de regresión multi-respuesta en el que el papel de cada variable, predictiva o respuesta, es desconocido de antemano. Los índices resultantes podrían ser muy útiles para la predicción, es decir, cuando se conocen sus valores, el conocimiento de cualquier valor no proporciona información sobre la predicción de otros índices bibliométricos. Un estudio bibliométrico sobre la investigación española en informática ha sido realizado bajo la cultura de publicar o morir. Este estudio se basa en una metodología de análisis de clusters que caracteriza la actividad en la investigación en términos de productividad, visibilidad, calidad, prestigio y colaboración internacional. Este estudio también analiza los efectos de la colaboración en la productividad y la visibilidad bajo diferentes circunstancias. ABSTRACT Machine learning and scientometrics are the scientific disciplines which are covered in this dissertation. Machine learning deals with the construction and study of algorithms that can learn from data, whereas scientometrics is mainly concerned with the analysis of science from a quantitative perspective. Nowadays, advances in machine learning provide the mathematical and statistical tools for properly working with the vast amount of scientometrics data stored in bibliographic databases. In this context, the use of novel machine learning methods in scientometrics applications is the focus of attention of this dissertation. This dissertation proposes new machine learning contributions which would shed light on the scientometrics area. These contributions are divided in three parts: Several supervised cost-(in)sensitive models are learned to predict the scientific success of articles and researchers. Cost-sensitive models are not interested in maximizing classification accuracy, but in minimizing the expected total cost of the error derived from mistakes in the classification process. In this context, publishers of scientific journals could have a tool capable of predicting the citation count of an article in the future before it is published, whereas promotion committees could predict the annual increase of the h-index of researchers within the first few years. These predictive models would pave the way for new assessment systems. Several probabilistic graphical models are learned to exploit and discover new relationships among the vast number of existing bibliometric indices. In this context, scientific community could measure how some indices influence others in probabilistic terms and perform evidence propagation and abduction inference for answering bibliometric questions. Also, scientific community could uncover which bibliometric indices have a higher predictive power. This is a multi-output regression problem where the role of each variable, predictive or response, is unknown beforehand. The resulting indices could be very useful for prediction purposes, that is, when their index values are known, knowledge of any index value provides no information on the prediction of other bibliometric indices. A scientometric study of the Spanish computer science research is performed under the publish-or-perish culture. This study is based on a cluster analysis methodology which characterizes the research activity in terms of productivity, visibility, quality, prestige and international collaboration. This study also analyzes the effects of collaboration on productivity and visibility under different circumstances.

A modelling language for the resilience assessment of networked systems of systems

Systems of Systems (SoS) present challenging features and existing tools result often inadequate for their analysis, especially for heteregeneous networked infrastructures. Most accident scenarios in networked systems cannot be addressed by a simplistic black or white (i.e. functioning or failed) approach. Slow deviations from nominal operation conditions may cause degraded behaviours that suddenly end up into unexpected malfunctioning, with large portions of the network affected. In this paper,we present a language for modelling networked SoS. The language makes it possible to represent interdependencies of various natures, e.g. technical, organizational and human. The representation of interdependencies is based on control relationships that exchange physical quantities and related information. The language also makes it possible the identification of accident scenarios, by representing the propagation of failure events throughout the network. The results can be used for assessing the effectiveness of those mechanisms and measures that contribute to the overall resilience, both in qualitative and quantitative terms. The presented modelling methodology is general enough to be applied in combination with already existing system analysis techniques, such as risk assessment, dependability and performance evaluation

Assessment of innovative measures implemented in European bus systems using key performance indicators

This paper reports the results of the assessment of a range of measures implemented in bus systems in five European cities to improve the use of public transport by increasing its attractiveness and enhancing its image in urban areas. This research was conducted as part of the EBSF project (European Bus System of the Future) from 2008 to 2012. New buses (prototypes), new vehicle and infrastructure technologies, and operational best practices were introduced, all of which were combined in a system approach. The measures were assessed using multicriteria analysis to simultaneously evaluate a certain number of criteria that need to be aggregated. Each criterion is measured by one or more key performance indicators (KPI) calculated in two scenarios (reference scenario, with no measure implemented; and project scenario, with the implementation of some measures), in order to evaluate the difference in the KPI performance between the reference and project scenario. The results indicate that the measures produce a greater benefit in issues related to bus system productivity and customer satisfaction, with the greatest impact on aspects of perceptions of comfort, cleanliness and quality of service, information to passengers and environmental issues. The study also reveals that the implementation of several measures has greater social utility than very specific and isolated measures.

Discrete element analysis for the assessment of the accuracy of load cell-based dynamic weighing systems in grape harvesters under different ground conditions

Dynamic weighing systems based on load cells are commonly used to estimate crop yields in the field. There is lack of data, however, regarding the accuracy of such weighing systems mounted on harvesting machinery, especially on that used to collect high value crops such as fruits and vegetables. Certainly, dynamic weighing systems mounted on the bins of grape harvesters are affected by the displacement of the load inside the bin when moving over terrain of changing topography. In this work, the load that would be registered in a grape harvester bin by a dynamic weighing system based on the use of a load cell was inferred by using the discrete element method (DEM). DEM is a numerical technique capable of accurately describing the behaviour of granular materials under dynamic situations and it has been proven to provide successful predictions in many different scenarios. In this work, different DEM models of a grape harvester bin were developed contemplating different influencing factors. Results obtained from these models were used to infer the output given by the load cell of a real bin. The mass detected by the load cell when the bin was inclined depended strongly on the distribution of the load within the bin, but was underestimated in all scenarios. The distribution of the load was found to be dependent on the inclination of the bin caused by the topography of the terrain, but also by the history of inclination (inclination rate, presence of static periods, etc.) since the effect of the inertia of the particles (i.e., representing the grapes) was not negligible. Some recommendations are given to try to improve the accuracy of crop load measurement in the field.

Contribution to the Analysis, Design and Assessment of Compact Antenna Test Ranges At Millimeter Wavelengths - Contribución al Análisis, Diseño y Caracterización de Sistemas de Medida de Antenas en Rango Compacto para Frecuencias Milimétricas

This Doctoral Thesis entitled Contribution to the analysis, design and assessment of compact antenna test ranges at millimeter wavelengths aims to deepen the knowledge of a particular antenna measurement system: the compact range, operating in the frequency bands of millimeter wavelengths. The thesis has been developed at Radiation Group (GR), an antenna laboratory which belongs to the Signals, Systems and Radiocommunications department (SSR), from Technical University of Madrid (UPM). The Radiation Group owns an extensive experience on antenna measurements, running at present four facilities which operate in different configurations: Gregorian compact antenna test range, spherical near field, planar near field and semianechoic arch system. The research work performed in line with this thesis contributes the knowledge of the first measurement configuration at higher frequencies, beyond the microwaves region where Radiation Group features customer-level performance. To reach this high level purpose, a set of scientific tasks were sequentially carried out. Those are succinctly described in the subsequent paragraphs. A first step dealed with the State of Art review. The study of scientific literature dealed with the analysis of measurement practices in compact antenna test ranges in addition with the particularities of millimeter wavelength technologies. Joint study of both fields of knowledge converged, when this measurement facilities are of interest, in a series of technological challenges which become serious bottlenecks at different stages: analysis, design and assessment. Thirdly after the overview study, focus was set on Electromagnetic analysis algorithms. These formulations allow to approach certain electromagnetic features of interest, such as field distribution phase or stray signal analysis of particular structures when they interact with electromagnetic waves sources. Properly operated, a CATR facility features electromagnetic waves collimation optics which are large, in terms of wavelengths. Accordingly, the electromagnetic analysis tasks introduce an extense number of mathematic unknowns which grow with frequency, following different polynomic order laws depending on the used algorithmia. In particular, the optics configuration which was of our interest consisted on the reflection type serrated edge collimator. The analysis of these devices requires a flexible handling of almost arbitrary scattering geometries, becoming this flexibility the nucleus of the algorithmia’s ability to perform the subsequent design tasks. This thesis’ contribution to this field of knowledge consisted on reaching a formulation which was powerful at the same time when dealing with various analysis geometries and computationally speaking. Two algorithmia were developed. While based on the same principle of hybridization, they reached different order Physics performance at the cost of the computational efficiency. Inter-comparison of their CATR design capabilities was performed, reaching both qualitative as well as quantitative conclusions on their scope. In third place, interest was shifted from analysis - design tasks towards range assessment. Millimetre wavelengths imply strict mechanical tolerances and fine setup adjustment. In addition, the large number of unknowns issue already faced in the analysis stage appears as well in the on chamber field probing stage. Natural decrease of dynamic range available by semiconductor millimeter waves sources requires in addition larger integration times at each probing point. These peculiarities increase exponentially the difficulty of performing assessment processes in CATR facilities beyond microwaves. The bottleneck becomes so tight that it compromises the range characterization beyond a certain limit frequency which typically lies on the lowest segment of millimeter wavelength frequencies. However the value of range assessment moves, on the contrary, towards the highest segment. This thesis contributes this technological scenario developing quiet zone probing techniques which achieves substantial data reduction ratii. Collaterally, it increases the robustness of the results to noise, which is a virtual rise of the setup’s available dynamic range. In fourth place, the environmental sensitivity of millimeter wavelengths issue was approached. It is well known the drifts of electromagnetic experiments due to the dependance of the re sults with respect to the surrounding environment. This feature relegates many industrial practices of microwave frequencies to the experimental stage, at millimeter wavelengths. In particular, evolution of the atmosphere within acceptable conditioning bounds redounds in drift phenomena which completely mask the experimental results. The contribution of this thesis on this aspect consists on modeling electrically the indoor atmosphere existing in a CATR, as a function of environmental variables which affect the range’s performance. A simple model was developed, being able to handle high level phenomena, such as feed - probe phase drift as a function of low level magnitudes easy to be sampled: relative humidity and temperature. With this model, environmental compensation can be performed and chamber conditioning is automatically extended towards higher frequencies. Therefore, the purpose of this thesis is to go further into the knowledge of millimetre wavelengths involving compact antenna test ranges. This knowledge is dosified through the sequential stages of a CATR conception, form early low level electromagnetic analysis towards the assessment of an operative facility, stages for each one of which nowadays bottleneck phenomena exist and seriously compromise the antenna measurement practices at millimeter wavelengths.

Assessment of Hydrogen as suistinable clean energy

The progressive depletion of fossil fuels and their high contribution to the energy supply in this modern society forces that will be soon replaced by renewable fuels. But the dispersion and alternation of renewable energy production also undertake to reduce their costs to use as energy storage and hydrogen carrier. It is necessary to develop technologies for hydrogen production from all renewable energy storage technologies and the development of energy production from hydrogen fuel cells and cogeneration and tri generation systems. In order to propel this technological development discussed where the hydrogen plays a key role as energy storage and renewable energy, the National Centre of Hydrogen and Fuel Cell Technology Experimentation in Spain equipped with installations that enable scientific and technological design, develop, verify, certify, approve, test, measure and, more importantly, the facility ensures continuous operation for 24 hours a day, 365 days year. At the same time, the system is scalable so as to allow continuous adaptation of new technologies are developed and incorporated into the assembly to verify integration at the same time it checks the validity of their development. The transformation sector can be said to be the heart of the system, because without neglecting the other sectors, this should prove the validity of hydrogen as a carrier - energy storage are important efforts that have to do to demonstrate the suitability of fuel cells or internal combustion systems to realize the energy stored in hydrogen at prices competitive with conventional systems. The multiple roles to meet the fuel cells under different conditions of operation require to cover their operating conditions, many different sizes and applications. The fourth area focuses on integration is an essential complement within the installation. We must integrate not only the electricity produced, but also hydrogen is used and the heat generated in the process of using hydrogen energy. The energy management in its three forms: hydrogen chemical, electrical and thermal integration requires complicated and require a logic and artificial intelligence extremes to ensure maximum energy efficiency at the same time optimum utilization is achieved. Verification of the development and approval in the entire production system and, ultimately, as a demonstrator set to facilitate the simultaneous evolution of production technology, storage and distribution of hydrogen fuel cells has been assessed.

A Model for Proactivity in Mobile, Context-aware Recommender Systems

A proactive recommender system pushes recommendations to the user when the current situation seems appropriate, without explicit user request. This is conceivable in mobile scenarios such as restaurant or gas station recommendations. In this paper, we present a model for proactivity in mobile recommender systems. The model relies on domain-dependent context modeling in several categories. The recommendation process is divided into two phases to first analyze the current situation and then examine the suitability of particular items. We have implemented a prototype gas station recommender and conducted a survey for evaluation. Results showed good correlation of the output of our system with the assessment of users regarding the question when to generate recommendations.

Methods and Tools for Objective Assessment of Psychomotor Skills in Laparoscopic Surgery

Training and assessment paradigms for laparoscopic surgical skills are evolving from traditional mentor–trainee tutorship towards structured, more objective and safer programs. Accreditation of surgeons requires reaching a consensus on metrics and tasks used to assess surgeons’ psychomotor skills. Ongoing development of tracking systems and software solutions has allowed for the expansion of novel training and assessment means in laparoscopy. The current challenge is to adapt and include these systems within training programs, and to exploit their possibilities for evaluation purposes. This paper describes the state of the art in research on measuring and assessing psychomotor laparoscopic skills. It gives an overview on tracking systems as well as on metrics and advanced statistical and machine learning techniques employed for evaluation purposes. The later ones have a potential to be used as an aid in deciding on the surgical competence level, which is an important aspect when accreditation of the surgeons in particular, and patient safety in general, are considered. The prospective of these methods and tools make them complementary means for surgical assessment of motor skills, especially in the early stages of training. Successful examples such as the Fundamentals of Laparoscopic Surgery should help drive a paradigm change to structured curricula based on objective parameters. These may improve the accreditation of new surgeons, as well as optimize their already overloaded training schedules.

Tools in Spanish Universities to facilitate the transmission from High School to University and their assessment.

Incoming students in the University have education deficiencies, so universities studies require a sound basis of scientific knowledge. In this project are analysed instruments to reinforcing knowledge in those areas related to the studies that students are about to embark on public Spanish universities. There are important differences among universities and, in each university there are great differences among titles. Initial courses (cursos cero) are widespread (in 50% of universities) that selfevaluation instruments (14 % of universities). It is necessary to improve diffusion of those instruments because it is not possible to evaluate them. So are proposed the next actuations: to make regular standard surveys for professors and students; to publish results of surveys; public universities should institutionalize their basic training offer and improve the dissemination of this offer especially through the web. This paper presents a questionnaire to assess student opinion about these tools. To analyze the effectiveness, and make an initial estimate of the evaluation of these tools, we conducted a pilot test of the questionnaire with 68 students at the University of Extremadura. The results of preliminary statistical analysis conducted on the pilot test indicate that the survey results are reliable. A global evaluation of both tools, with a scale of 1 to 5, gave an average score of 3.29 for initial courses and 3.41 for selfevaluation. The 72.9% of the students consider the "self assessment" more effective than the "initial course"

Safety assessment of underground vehicles passing over highly resilient straight tracks in the presence of a broken rail

In this paper, vehicle-track interaction for a new slab track design, conceived to reduce noise and vibration levels has been analyzed, assessing the derailment risk for trains running on curved track when encountering a broken rail. Two different types of rail fastening systems with different elasticities have been analysed and compared. Numerical methods were used in order to simulate the dynamic behaviour of the train-track interaction. Multibody system (MBS) modelling techniques were combined with techniques based on the finite element method (FEM). MBS modelling was used for modelling the vehicle and FEM for simulating the elastic track. The simulation model was validated by comparing simulated results to experimental data obtained in field testing. During the simulations various safety indices, characteristic of derailment risk, were analysed. The simulations realised at the maximum running velocity of 110 km/h showed a similar behaviour for several track types. When reducing the running speed, the safety indices worsened for both cases. Although the worst behaviour was observed for the track with a greater elasticity, in none of the simulations did a derailment occur when running over the broken rail.